Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 18-1762 | AZ |
NPI | 1053950667 |
---|---|
Provider Name | Dr. Edward L Griffen |
First Address | Flagstaff, AZ 86004-8576 |
Second Address | Flagstaff, AZ 86004-8576 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2019 |
Last Update Date | 30/12/2019 |